Telemedicine extends trauma care to rural areas

It was late on a July afternoon in 2005, and 11-year-old Austin Landowski was having a blast riding his Honda 80 motorcycle.

But as the boy was going down a hill near his family's summer cabin in Northern California's Trinity Mountains, fun quickly turned to terror when he lost control, went airborne and landed hard on a fallen oak tree. His motorcycle came crashing down on top of him. All he could do was lie there until his grandfather found him some time later.

He was taken by ambulance to the nearest sizeable hospital, Mercy Medical Center in Redding. His parents, at their home on the coast in Eureka, drove three hours on a twisting mountain road to join him. The news at the hospital was not good: broken ribs; a ruptured spleen; in critical condition.

"They were talking about a blood transfusion and removing his spleen," recalls the youth's father, Bill Landowski.

Aside from the fear any parent would have in such a situation, Landowski had another concern. He and his wife, Lisa, are Jehovah's Witnesses — their faith bars them from accepting any foreign blood products.

Landowski informed hospital officials of the family's beliefs and suggested alternatives to blood transfusions that his church had researched, such as the drug erythropoietin.

Although contemplating surgery, the medical team, he says, decided to seek a second opinion — one that couldn't have taken place without the availability of the latest technology. Through a video-conference hookup, physician Kourosh Parsapour, a pediatric critical-care specialist at UC Davis Medical Center, was brought into Austin's hospital room to evaluate the boy.

Parsapour was able to participate in the live, interactive visit through a technology called telemedicine, enabled by high-speed data lines linked to video units at Mercy in Redding and UC Davis Medical Center in Sacramento.

Linking to rural hospitals

In addition to the Redding hospital, such connections exist at three other inpatient wards and nine emergency rooms of rural hospitals stretching from Willets, Calif., to Susanville, Calif., to Fallon, Nev., according to James Marcin, pediatric intensivist and director of pediatric telemedicine at UC Davis. The system will soon include Oroville's emergency department.

Telemedicine gives rural doctors, who typically don't have pediatric intensive-care training, real-time access to specialists. Sometimes the patient's condition is so dire that emergency air transport to the medical center in Sacramento is the only option. But the inherent risk in travel — not to mention the expense — can often be avoided when UC Davis specialists use telemedicine to help a doctor on the scene stabilize the patient.

"We'll look over their shoulders and help them to manage the child locally," says Marcin.

UC Davis pediatric intensivists have conducted just over 200 video-based consultations with remote site ERs and intensive care units since the system was established six years ago, with about 30 percent of the consults involving trauma.

UC Davis also provides a wide range of consultation services for adult and pediatric problems as well as distance learning opportunities for rural physicians.

Widespread support

Support for UC Davis' telemedicine program comes from many sources. Just last November, California voters approved state Proposition 1D, which allocates $200 million to expand UC medical school programs and enhance their telemedicine efforts, including UC Davis'.

In addition, foundation and corporate sponsorships support the rural outreach, as does a recent donation by longtime Sacramentans Lillie and Millard Tonkin. The couple donated $25,000 to UC Davis' telemedicine program and $25,000 to the Frank R. Howard Hospital in Willets, Calif., to facilitate a link between the two hospitals. The Tonkins gave the gift in memory of Millard's father, a traveling salesman who had a special interest in bringing health care to rural areas.

Austin recovers

In Austin's case, UC Davis pediatric intensivist Parsapour was able to "quickly and comfortably" determine that a flight to Sacramento was unnecessary."

Austin wasn't lethargic or listless, and he could talk to me," Parsapour recalls. "It was clear he was in pain, but he looked stable. He was having trouble breathing because of the rib fractures, but his respiratory pattern seemed stable.

"If his breathing had worsened," Parsapour continues, "we would have transported him. Instead, I was able to determine, at least at that point in time, that there was nothing that required that kind of aggressive intervention."

Nevertheless, Austin was not out of the woods. Instead of a blood transfusion — the normal course to take until a spleen heals — Parsapour recommended putting Austin on erythropoietin, a medication Austin's father had mentioned earlier that stimulates bone marrow to make more red blood cells. The Sacramento pediatric specialist checked on the boy via video-conferencing over the next four days to observe his progress.

"We were buying time, waiting for the medicine to work, so that we could avoid taking the spleen out and avoid a transfusion out of respect for the family's religious beliefs," Parsapour says.

The treatment worked. After six days, Austin headed home from the Redding hospital. Today, he is 13, his spleen is fully recovered, and the blood in his body is all his own.

"I truly believe that without telemedicine, Austin's spleen would have been removed, and he probably would have had blood transfusions," his father says.